Quantitative Assessment of Ethmoidal Air Cell Variations by Age and Gender Using Cone-Bone Computed Tomography

Objectives: Ethmoidal air cell variants such as Agger nasi, Haller, Onodi, uncinate, and ethmoid bullae are critical anatomical structures influencing the outcomes of functional endoscopic sinus surgery (FESS). This study evaluated their prevalence and gender-specific distribution in a Sangli, Maharashtra, India, via cone beam computed tomography (CBCT). Materials and Methods: A cross-sectional retrospective analysis of 258 CBCT scans (150 males, 108 females; ages 18–65) was conducted. The presence of five defined ethmoidal variations was recorded (absent/unilateral/bilateral). Two radiologists independently assessed images; disagreements were resolved by consensus. Statistical significance in gender distribution was tested via the Chi-square test ( P < 0.05 considered significant). Results: Onodi cells were observed in 96 cases (32%), Haller in 53 (17.7%), Agger nasi in 31 (10.3%), uncinate bulla in 8 (2.7%), and prominent ethmoid bulla in 5 (1.7%). Gender distribution showed male predominance in all variants except uncinate bulla, but none achieved statistical significance ( P > 0.05). Conclusions: Onodi and Haller cells exhibit high prevalence, emphasizing the necessity for thorough pre-FESS CBCT evaluation. Despite non-significant gender differences, these variations should be carefully assessed in individual patients. The findings support the role of personalized radiological analysis to reduce surgical risks.